Table 2.

Common Herbs Used in Children and Adolescents

HERBHERBALISTS’ CLASSIFICATIONTYPICAL USESEVIDENCE BASED ON CLINICAL TRIALSSIDE EFFECTS AND DRUG INTERACTIONS
Aloe Vera• Anti-inflammatoryExternal use: Applied topically to treat minor burns, abrasions, insect bites, acne, poison ivy, sunburn, skin irritations, frostbite, and canker sores• Aloe vera has been an effective topical vulnerary in treating leg ulcers, frostbite, full-face dermabrasions, and partial-thickness burn wounds. In one study of aloe as a treatment for surgical wound healing, the aloe group had delayed healing compared with controls.Side Effects of leaf lining taken internally: Contact dermatitis, gastric cramping, or diarrhea.2
• AntimicrobialInternal use: Gel taken as a peptic ulcer remedy and treatment for digestive disorders• A double-blind, placebo-controlled study demonstrated the healing effect of aloe on psoriasis vulgaris.Pregnancy and lactation:1
• LaxativeLeaf lining used as a laxative• Experimental trials in human immunodeficiency virus-positive adults have had conflicting results in terms of immunomodulatory effects.Drug Interactions for leaf lining: May potentiate digitalis and cardiac glycosides due to increased potassium loss. May enhance potassium loss with corticosteroids and thiazide diuretics.
• VulneraryOther: Reduced absorption of drugs due to decreased bowel transit time.
Calendula (Calendula officinalis)• Anti-inflammatoryExternal use: Skin irritations, rashes, cold sores, eczema, and conjunctivitis• A few clinical trials support topical use to accelerate wound healing and ulcers.Side Effects:2
• AntisepticPregnancy and lactation:1
• AntispasmodicDrug Interactions: None known.
• Vulnerary
Catnip (Nepetia cataria)• AntipyreticLow-grade fever, upper respiratory tract infection, colic, headache, nervousness, sleep disorders, indigestion• No clinical studies.Side Effects: One case report of central nervous system depression in toddler.2
• AntispasmodicPregnancy and lactation:1
• CalmativeDrug Interactions: None known.
• Carminative
• Diaphoretic
Digestive aid
• Diuretic
• Sedative
Chamomile (Anthemis nobilis)• Anti-inflammatoryExternal use: Skin irritation, prevention and treatment of cracked nipples• In controlled trials, chamomile and its constituents have had positive effects on wound healing, as a mild sedative, and in combination with other herbs as a treatment for infant colic.Side Effects:2
• AntispasmodicInternal use: Colic, peptic ulcer disease, eething, sleep problems, anxiety• Mixed results in the efficacy of the treatment of chemotherapy/radiation-induced mucositis.Pregnancy and lactation: No known adverse effects in pregnancy, lactation, and childhood.
• CarminativeDrug Interactions: None known.
• Nervine
• Sedative
• Vulnerary
Evening Primrose Oil (Oenothera biennis)• Anti-inflammatory• Asthmatic coughs, whooping cough, gastrointestinal disorders• No studies on asthma or diphtheria.Side Effects: Gastrointestinal disturbances and headaches2
• Sedative• Mastalgia, premenstrual syndrome (PMS)• Effective in treatment of mastalgia; unclear effect in treatment of fibrocystic breast disease. A meta-analysis of seven placebo-controlled trials found little value in managing PMS, although these studies were small.Pregnancy and Lactation:1
• Anticoagulant• Atopic eczema, psoriasis, acne• Data on effectiveness in treating atopic dermatitis and other dermatologic disorders are mixed.Drug Interactions: None known, but caution is suggested for patients taking phenothiazine and other drugs that reduce the seizure threshold.
• Astringent• Rheumatoid arthritis, multiple sclerosis, and other autoimmune diseases• Preliminary studies appear promising for treatment of rheumatoid arthritis.
• Diabetic neuropathy, intermittent claudication• Effective in treating diabetic neuropathy in two studies.
Fennel (foeniculum vulgare)• Antimicrobial• Colic, dyspnea, bloating, fullness, flatulence and diarrhea in infants• One study showed an herbal combination including fennel was helpful in treating colic.Side Effects:2
• Antispasmodic• Cough, bronchitis, upper respiratory tract infection, conjunctivitisPregnancy and lactation:1
• CarminativeDrug Interactions: None known.
• Diuretic
• Galactagogue
• Expectorant
• Mild laxative
Feverfew (Tanacetum parthenicum)• Anti-inflammatory• Migraine headache, nausea and vomiting, arthritis, fever• Clinical research in migraine treatment or prophylaxis shows mixed results, but tends to support feverfew as a prophylactic agent.Side Effects: Rebound headache, oral ulcers, and gastric disturbances.2
• Antipyretic• Not helpful in one study of treatment of rheumatoid arthritis.Pregnancy and lactation:1
• AntispasmodicDrug Interactions: May potentiate effects of anticoagulants and aspirin.
Garlic (Allium sativum)• Anti-inflammatory• Ear infections, upper respiratory tract infection, cough/bronchitis, atherosclerosis, high cholesterol, hypertension, gastrointestinal disorders, menstrual disorders, diabetes mellitus• Mild beneficial effect on serum lipids and reducing serum cholesterol, serum triglycerides, and low-density lipoprotein cholesterol. Modest antihypertensive effect.Side Effects: Flatulence, heart burn, gastric disturbances.2
• Antimicrobial• A randomized, double-blind, placebo-controlled clinical trial found no change in cardiovascular risk factors compared with placebo in children who had familial hyperlipidemia.Pregnancy and lactation: Reported emmenagogue in large amounts.1
• AntioxidantDrug Interactions: Inhibits platelet aggregation, prolongs bleeding and clotting times, and has fibrinolytic activity. Use large doses with caution for patients taking anticoagulants and anti-inflammatory drugs.
• Antispasmodic
• Carminative
• Diaphoretic
• Diuretic
• Expectorant
• Hypoglycemic
• Hypotensive
• Lipid-lowering
• Stimulant
Ginger (Zingiber officinale)• Antiemetic• Colic, anorexia; indigestion; prevention of vomiting and nausea in motion sickness, morning sickness, and postoperative nausea; upper respiratory tract infection, cough, and bronchitis• Mixed results for treatment for motion sickness and postsurgical nausea and vomiting.Helpful in treating hyperemesis gravidarum.Side Effects: Heartburn2
• AntispasmodicContraindictions: Patients with gallstones due to cholagogue effect.
• AntiviralPregnancy and lactation:1
• CarminativeDrug Interactions: May potentiate anticoagulants
• Immune modulator
• Stimulates digestion
Ginkgo biloba• Anticoagulant at high doses• Improving circulation in the brain and periphery• Controlled trials reported positive results in the treatment of chronic cerebral insufficiency.Side Effects: Headache, dizziness, palpitation, gastrointestinal disorder, dermatitis2
• Vasoactive• Arteriosclerosis, cerebral ischemia, claudication• Several double-blind, placebo-controlled trials studying patients who have memory loss showed some improvement in memory.Pregnancy and lactation:1
• Alzheimer disease, dementia, senility• Randomized controlled studies showed promise in treating memory loss and psychopathologic conditions in Alzheimer disease and dementia.Drug Interactions: May potentiate other anticoagulants; can hinder blood clotting at high doses.
• Arthritic and rheumatic problems• Controlled studies on intermittent claudication showed favorable results.
• Lung and bronchial congestion, Raynaud disease, tinnitus, vertigo, attention deficit hyperactivity disorder• No studies on pulmonary problems or attention deficit hyperactivity disorder.
Goldenseal (Hydratis canadensis)• AntihemorrhagicExternal use: Conjunctivitis, boils, inflammation of gums, hemorrhoids, fungal infections• Randomized controlled studies demonstrate that berberine, a constituent of goldenseal, is effective in treating diarrhea.Side Effects: For large doses, nausea, vomiting, diarrhea, mucocutaneous irritation; increased cardiac and uterine contractility, vasoconstriction, central nervous system stimulation, and neonatal jaundice.
• Anti-inflammatoryInternal use: Diarrhea and other digestive disorders, upper respiratory tract infection, postpartum bleeding• No clinical studies on treatment of conjunctivitis, upper respiratory tract infection, or postpartum bleeding.Pregnancy and lactation: Avoid in pregnancy and lactation. Not recommended for infants. Berberine displaces bilirubin from albumin.
• AntimicrobialDrug Interactions: None known.
• Antiseptic
• Astringent
• Digestive aid
• Oxytocic
• Vulnerary
Hops (Humulus lupulus)• Antispasmodic• Nervousness, irritability, insomnia, indigestion• No clinical studies.Side Effects:2, skin irritation
• BittersPregnancy and lactation:1
• DiureticDrug Interactions: Sedative activity increases the sleeping time induced by pentobarbital.
• Hypnotic
• Sedative
Lemon balm (Melissa officinalis)• Antispasmodic• Oral and genital herpes, insomnia, anxiety, depression• One study showed a sleep-promoting effect of the combination of valerian and lemon balm.Side Effects:2
• AnxiolyticDrug Interactions: None known.
• CalmativeDrug Interactions: None known.
• Digestive aid
Licorice (Glycyrrhiza glabra)• Adrenocorticotropic• Asthma, cough, sore throat, upper respiratory tract infection, bronchitis, stomach ulcers and digestive disturbances, constipation, colic, cholestatic liver disorders and liver disease, adrenocorticoid insufficiency, hypokalemia, hypertonia, arthritis• Licorice, in combination with other herbs, was effective in treating infant colic.Side Effects: Long-term use may lead to a mineralocorticoid effect, hypertension, potassium wasting, and arrhythmias.2
• Anti-inflammatory• Constituents of licorice have proven effective in treating gastric ulcer in several studies.Pregnancy and lactation:1
• Antiviral• Licorice, combined with other Chinese herbs, appears effective in treating severe eczema.Contraindications: Patients who have hypertension, diabetes, hypokalemia, liver disorders, or kidney disease.
• AntispasmodicDrug Interactions: May potentiate digitalis and cardiac glycosides due to increased potassium loss. May increase potassium loss in patients taking corticosteroids and thiazude diuretics.
• Antitussive
• Antiulcer
• Demulcent
• Expectorant
• Laxative
Peppermint (Mentha piperita)• AntimicrobialExternal use: Muscle aches, neuralgia, headache• Enteric-coated peppermint oil capsules appear helpful in the treatment of irritable bowel syndrome/spastic colon. Peppermint oil relieves intestinal spasms during barium enema and endoscopy.Side Effects: Abdominal pain, heartburn, and perianal burning or hypersensitivity reactions.2
• Digestive aidInternal use: Indigestion, nausea, diarrhea, flatulent colic, anorexia, inflammatory bowel disease, spastic complaints of the gastrointestinal tract as well as gallbladder and bile ducts, upper respiratory tract infection, cough, tension headache• Clinical trials have examined a positive role in treating postoperative nausea, nonulcer dyspepsia in combination with caraway oil, and tension-type headaches.Contraindications: Biliary duct occlusion, gallbladder inflammation, liver disease, and gastroesophageal reflux disease. Patients who have gallstones could develop colic due to peppermint’s cholagogic effect.
• CarminativePregnancy and lactation:1
• AntispasmodicDrug Interactions: None known.
• Cholagogic
• Secretolytic
• Stimulant
Purple Cone Flower (Echinacea angustifolia or E purpurea)• Anti-inflammatoryExternal use: Boils, ulcerations, burns, herpes simplex• Controlled studies for Echinacea as an immune modulator to prevent and treat colds and influenza showed mixed results. Several randomized, double-blind, placebo-controlled studies showed a reduction in cold symptoms. However, in one study, Echinacea did not significantly decrease the incidence, duration, or severity of colds and respiratory infections compared with placebo.Side Effects: Dermatitis2
• AntimicrobialInternal use: Prevention and supportive therapy for upper respiratory tract infection, urinary tract infection, yeast infection, and other infections.Pregnancy and lactation:1
• AntisepticDrug Interactions: Possible unknown interactions with other immunomodulators.
• Immune modulator
• Peripheral vasodilator
Slippery Elm Bark (Ulmus fulva)• AntitussiveExternal use: Minor skin irritations, cold sores, ulcers, abscesses, and boils• No clinical studies.Side Effects: Dermatitis2
• AntiviralInternal use: Diarrhea, colic, inflammation or ulcerations of stomach or duodenum, urinary tract infections, sore throats, upper respiratory tract infections, abortifacientDrug Interactions: None known.
• DemulcentPregnancy and lactation:1 The whole bark has been used to induce abortions. There are no reported problems with the use of powdered slippery elm.
• Digestive aid
• Emollient
St. Johns Wort (Hypericum perforatum)• AntidepressantExternal use: Wounds, burns, neuralgia, contusions• Double-blind, randomized, controlled trials demonstrate significant effectiveness in the treatment of mild-to-moderate depression.Side Effects: Gastrointestinal symptoms, sedation, dizziness, and confusion. Photosensitivity is rare but can be severe.2
• Anti-inflammatoryInternal use: Depression, nervousness, anxiety• Pilot case series have shown encouraging effects on immune function in human immunodeficiency virus-positive patients.Pregnancy and lactation:1
• AstringentDrug Interactions: None known.
• Antimicrobial
• Sedative
• Immunomodulator
Thyme (Thymus vulgaris)• Antimicrobial• Bronchitis/cough, sore throat, upper respiratory tract infection, indigestion, colic, gastritis, dyspepsia, diarrhea, and enuresis• No clinical studies specifically on thyme.Side Effects: Thyme essential oil can be a mucous membrane irritant.2
• Antitussive• An herbal combination that included thyme had positive effects on alopecia.Pregnancy and lactation:1
• AstringentDrug Interactions: None known.
• Carminative
• Antispasmodic
• Antiseptic
• Diuretic
• Expectorant
Valerian (Valeriana officianalis)• Anodyne• Insomnia, restlessness, menstrual cramps, rheumatic pain• Randomized, double-blind, placebo-controlled studies showed decreased sleep latency and improved sleep quality.Side Effects: Headaches, insomnia2
• AntispasmodicPregnancy and lactation:1
• HypnoticDrug Interactions: Sedative activity increases the sleeping time induced by pentobarbital.
• Hypotensive
• Sedative